Resumption of elective orthopaedic surgery in the us epicenter of covid-19

© 2020 Krauss et al. On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption of urgent elective procedures, this hospital became one of the two designated sites within the Northwell Health system to be “non-COVID.” Once the hospital was emptied of all inpatients, a complete and thorough cleaning and disinfection was performed on the entire building. All equipment was thoroughly decontaminated following Centers for Disease Control and Prevention (CDC) guidelines. In anticipation of the resumption of elective surgery, each surgeon evaluated their cancelled case list to determine patient priority, based on a scale of 1 (elective, non-urgent), 2 (semi-urgent), 3 (urgent), to 4 (highly urgent). Site-specific disaster credentialing was expedited so that emergent surgeries could be performed by surgeons located at other Northwell sites. To ensure a structured and informative onboarding process, each visiting surgeon received a “welcome” email which requested pertinent information to facilitate the surgical process. Presurgical, surgical, and postoperative protocols were revised based on federal and local guidance and regulations. Resumption of elective surgery post COVID-19 placed the hospital into uncharted territory

Lessons Learned: Using the Caprini Risk Assessment Model to Provide Safe and Efficacious Thromboprophylaxis Following Hip and Knee Arthroplasty

© The Author(s) 2020. Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient’s risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care

Drivers of plant diversity in Bulgarian dry grasslands vary across spatial scales and functional-taxonomic groups

Questions: Studying dry grasslands in a previously unexplored region, we asked: (a) which environmental factors drive the diversity patterns in vegetation; (b) are taxonomic groups (vascular plants, bryophytes, lichens) and functional vascular plant groups differently affected; and (c) how is fine-grain beta diversity affected by environmental drivers? Location: Northwestern and Central Bulgaria. Methods: We sampled environmental data and vascular plant, terricolous bryophyte and lichen species in 97 10-m2 plots and 15 nested-plot series with seven grain sizes (0.0001–100 m2) of ten grassland sites within the two regions. We used species richness as measure of alpha-diversity and the z-value of the power-law species–area relationship as measure of beta-diversity. We analysed effects of landscape, topographic, soil and land-use variables on the species richness of the different taxonomic and functional groups. We applied generalised linear models (GLMs) or, in the presence of spatial autocorrelation, generalised linear mixed-effect models (GLMMs) in a multi-model inference framework. Results: The main factors affecting total and vascular plant species richness in 10-m2 plots were soil pH (unimodal) and inclination (negative). Species richness of bryophytes was positively affected by rock cover, sand proportion and negatively by inclination. Inclination and litter cover were also negative predictors of lichen species richness. Elevation negatively affected phanerophyte and therophyte richness, but positively that of cryptophytes. A major part of unexplained variance in species richness was associated with the grassland site. The z-values for total richness showed a positive relationship with elevation and inclination. Conclusions: Environmental factors shaping richness patterns strongly differed among taxonomic groups, functional vascular plant groups and spatial scales. The disparities between our and previous findings suggest that many drivers of biodiversity cannot be generalised but rather depend on the regional context. The large unexplained variance at the site level calls for considering more site-related factors such as land-use history

Dilemmas concerning heart procurement in controlled donation after circulatory death

With an expanding population at risk for heart failure and the resulting increase in patients admitted to the waiting list for heart transplantation, the demand of viable organs exceeds the supply of suitable donor hearts. Use of hearts after circulatory death has reduced this deficit. Two primary techniques for heart procurement in circulatory death donors have been described: direct procurement and perfusion and thoraco-abdominal normothermic regional perfusion. While the former has been accepted as an option for heart procurement in circulatory death donors, the latter technique has raised some ethical questions in relation to the dead donor rule. In this paper we discuss the current dilemmas regarding these heart procurement protocols in circulatory death donors.</p

Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis

© The Author(s) 2019. Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk assessment. We compared the results of our prospective department protocol to the Caprini risk assessment model (RAM) retrospectively in this study group. Our goal was to determine whether the department protocol or the Caprini score would identify venous thromboembolism (VTE) events after total joint replacement. A secondary purpose was to validate the 2013 Caprini RAM in joint arthroplasty and determine whether patients with VTE would be accurately identified using the Caprini score. A total of 1078 patients met inclusion criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or less is considered low risk. The 2013 version of the Caprini RAM retrospectively stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the prospective department protocol. This tool provided a consistent, accurate, and efficacious method for risk stratification and selection of chemoprophylaxis

Physical and Biogeochemical Studies in the Subtropical and Tropical Atlantic

Maria S. Merian Cruise Report MSM18/L2 Cruise No. 18, Leg 2 May 11 – June 19, 2011 Mindelo (Cape Verde Islands) – Mindelo (Cape Verde Islands